Commotio cordis is a sudden disturbance of heart rhythm observed nowadays mostly in young people during participation in sports. It occurs as the result of a blunt, non-penetrating impact to the precordial region, often caused by impact of a ball, a bat or other projectile. The impact is transmitted to the heart muscle, and it may affect the heart's electrical activity, causing an arrhythmia, such as an ectopic beat, ventricular tachycardia or ventricular fibrillation. In addition, pre-existing conditions, such as undetected electrical or structural abnormalities in the heart of these individuals, may render individuals more vulnerable.
The best treatment for commotio cordis is to prevent it from occurring. In particular, the use of adequate protective equipment during athletic activity can greatly reduce the occurrence of commotion cordis. The protective equipment must meet certain safety standards; it has to reduce the incidence of the injury it is intended to prevent without increasing the risk for other injuries. Having every lacrosse player wear chest protectors or changing the ball to a “softer” projectile may seem like good ideas, but a scientific approach to the development of safety equipment is critical to ensure risk reduction. There is some basic science evidence that safety baseballs may reduce the incidence of sudden death from chest wall impacts in low velocity sports (T-ball, little league baseball). But deaths have still occurred when the ball has been altered.
Protective equipment changes the way that an athlete plays the game. A chest protector on a defenseman or midfielder would likely lead to more players jumping in front of attackers in an attempt to block high speed shots, which could lead to more tragic events if the equipment does not significantly reduce the risk of commotio cordis.
In theory, a light weight shoulder pad or chest protector with a hard protective shell and a soft padding undersurface over the front of the chest would spread the force of an impact on the chest wall over a wider surface area, thus reducing amount of energy transmitted to the heart after a chest blow. This could reduce the risk of commotio cordis. Any safety equipment recommended must not affect the player's movement or the ability to pass and shoot with both hands. In addition, it ideally should not change the player's actions during the game by giving the wearer an added sense of security. The least obtrusive device that affords the desired protection would be preferred.